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    Prevalence and test characteristics of national health safety network ventilator-associated events

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    Authors
    Lilly, Craig M.
    Landry, Karen
    Sood, Rahul N.
    Dunnington, Cheryl H.
    Ellison, Richard T. III
    Bagley, Peter H.
    Baker, Stephen P.
    Cody, Shawn
    Irwin, Richard S.
    UMass Chan Affiliations
    Graduate School of Nursing
    Department of Information Services
    Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine
    Department of Medicine, Division of Infectious Diseases and Immunology
    Document Type
    Journal Article
    Publication Date
    2014-09-01
    Keywords
    APACHE
    Academic Medical Centers
    Female
    Hospital Mortality
    Humans
    Intensive Care Units
    Length of Stay
    Male
    Middle Aged
    Patient Safety
    Pneumonia, Ventilator-Associated
    Prevalence
    Prospective Studies
    Public Health Surveillance
    Quality Indicators, Health Care
    Risk Factors
    Allergy and Immunology
    Critical Care
    Infectious Disease
    Pulmonology
    Respiratory Tract Diseases
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    Link to Full Text
    http://dx.doi.org/10.1097/CCM.0000000000000396
    Abstract
    OBJECTIVES: The primary aim of the study was to measure the test characteristics of the National Health Safety Network ventilator-associated event/ventilator-associated condition constructs for detecting ventilator-associated pneumonia. Its secondary aims were to report the clinical features of patients with National Health Safety Network ventilator-associated event/ventilator-associated condition, measure costs of surveillance, and its susceptibility to manipulation. DESIGN: Prospective cohort study. SETTING: Two inpatient campuses of an academic medical center. PATIENTS: Eight thousand four hundred eight mechanically ventilated adults discharged from an ICU. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The National Health Safety Network ventilator-associated event/ventilator-associated condition constructs detected less than a third of ventilator-associated pneumonia cases with a sensitivity of 0.325 and a positive predictive value of 0.07. Most National Health Safety Network ventilator-associated event/ventilator-associated condition cases (93%) did not have ventilator-associated pneumonia or other hospital-acquired complications; 71% met the definition for acute respiratory distress syndrome. Similarly, most patients with National Health Safety Network probable ventilator-associated pneumonia did not have ventilator-associated pneumonia because radiographic criteria were not met. National Health Safety Network ventilator-associated event/ventilator-associated condition rates were reduced 93% by an unsophisticated manipulation of ventilator management protocols. CONCLUSIONS: The National Health Safety Network ventilator-associated event/ventilator-associated condition constructs failed to detect many patients who had ventilator-associated pneumonia, detected many cases that did not have a hospital complication, and were susceptible to manipulation. National Health Safety Network ventilator-associated event/ventilator-associated condition surveillance did not perform as well as ventilator-associated pneumonia surveillance and had several undesirable characteristics.
    Source
    Crit Care Med. 2014 Sep;42(9):2019-28. doi: 10.1097/CCM.0000000000000396. Link to article on publisher's site
    DOI
    10.1097/CCM.0000000000000396
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/34989
    PubMed ID
    24810522
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1097/CCM.0000000000000396
    Scopus Count
    Collections
    UMass Chan Faculty and Researcher Publications
    Tan Chingfen Graduate School of Nursing Scholarly Publications

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